Traumatic occipito-cervical dissociation in adults: a Middle Eastern cohort study

• Published in: European journal of orthopaedic surgery & traumatology 2018-04, Vol.28 (3), p.381-387
• Main Authors: Menon, K. Venugopal, Al Habsi, Ismail, Al Ghafri, Khalifa
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Adult; Cervical Vertebrae - injuries; Cervical Vertebrae - surgery; Cohort analysis; Female; Head injuries; Humans; Joint Dislocations - surgery; Male; Medical imaging; Medicine; Medicine & Public Health; Mortality; Occipital Bone - injuries; Oman; Original Article • SPINE - TRAUMA; Patients; Retrospective Studies; Spinal Fractures - surgery; Spinal Fusion - instrumentation; Spinal Fusion - methods; Spinal Injuries - surgery; Surgical Orthopedics; Time-to-Treatment; Tomography, X-Ray Computed; Trauma; Traumatic Surgery
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-017-2053-2

The objective of this study is to describe a series of cranio-cervical dissociation victims and evaluate their outcomes as well as discuss the clinical dilemmas we faced in the context of current literature evidence. This is a retrospective cohort study of traumatic occipito-cervical dissociation in five patients (three males and two females) encountered between 2010 and 2016 at a tertiary care facility in the Middle East region. All patients underwent occipito-cervical fusion using screws and rods system with mean postoperative follow-up period of 2.5 years. All patients survived, and four were independently mobile and one wheel chair bound. Most had some degree of neurological sequelae, often due to associated injuries and all complained of limited neck range of motion. Contemporary literature review shows that CT scan with MRI is often the best diagnostic modality. Surgery is usually indicated though rare cases treated conservatively have been reported. The commonest predictor of mortality is missed injury, associated head injury and wide separation between the skull base and C1 on imaging studies.